CAJ | 학술논문

患者男,73岁.左小腿红斑、斑块伴微痒2年,加重为结节、肿块伴疼痛半年余.皮肤科检查:左小腿伸侧、腓侧中下1/3处多个大小不一红斑、斑块、结节、肿块.肿块质地坚韧,基底深在,可活动,边界不清,压痛明显.肿块表面皮肤部分外观正常.组织病理学检查:表皮未见明显异常;真皮中下部及皮下脂肪层可见梭形细胞及大小不一、胞体大、胞质红染、核大、浓染不规则的细胞,呈片状分布,其中可见病理性核分裂象,间质内可见淡蓝染物质,其间杂有淋巴细胞浸润.间质阿新蓝染色阳性.免疫组化染色:梭形细胞及异形大细胞弥漫性强阳性表达波形蛋白(Vim),30％～ 40％瘤细胞表达Ki67,CD34和CD68部分细胞阳性,而白细胞共同抗原、人黑素瘤S100蛋白、pCK、CD31、平滑肌肌动蛋白及结蛋白均为阴性.诊断:黏液炎性纤维母细胞肉瘤.
환자남,73세.좌소퇴홍반、반괴반미양2년,가중위결절、종괴반동통반년여.피부과검사:좌소퇴신측、비측중하1/3처다개대소불일홍반、반괴、결절、종괴.종괴질지견인,기저심재,가활동,변계불청,압통명현.종괴표면피부부분외관정상.조직병이학검사:표피미견명현이상;진피중하부급피하지방층가견사형세포급대소불일、포체대、포질홍염、핵대、농염불규칙적세포,정편상분포,기중가견병이성핵분렬상,간질내가견담람염물질,기간잡유림파세포침윤.간질아신람염색양성.면역조화염색:사형세포급이형대세포미만성강양성표체파형단백(Vim),30％～ 40％류세포표체Ki67,CD34화CD68부분세포양성,이백세포공동항원、인흑소류S100단백、pCK、CD31、평활기기동단백급결단백균위음성.진단:점액염성섬유모세포육류.
A 73-year-old male presented with mildly pruritic erythematous papules and plaques on the left leg for two years,which had developed into painful nodules and masses for half a year.Dermatological examination revealed multiple irregularly sized erythematous patches,plaques,nodules and masses on the distal one third of the extensor and fibular aspects of the left leg.The masses were hard,deeply infiltrating into the subcutaneous layer and ill-defined with tenderness and limited mobility.The skin covering the masses was partly normal.Histopathologically,there were focal aggregates of spindle cells and large cells of uneven size with red-stained cytoplasm and irregularly-shaped,heavily-stained huge nuclei in the mid and deep dermis as well as subcutaneous fat layer,with no obvious abnormality in the epidermis.Atypical mitoses were seen.There were light blue-stained substances admixed with lymphocytes in the Alcian blue-stained stroma.Immunohistochemistry revealed that the spindle cells and atypical large cells diffusely expressed vimentin.Of the tumor cells,30％-40％ stained positive for Ki67,some for CD34 and CD68,while all stained negative for leukocyte common antigen,S100,pan cytokeratin,CD31,smooth muscle actin and desmin.A diagnosis of myxoinflammatory fibroblastic sarcoma was made.